Determine treatment plan

Make decisions regarding liver disease severity,
treatment
and
other evaluations as appropriate.

Refer to care and treatment services for HCV infection, liver disease and other related conditions.

The Hepatitis C Screening and Evaluation: Clinical Decision Tool was originally published in Gastroenterology. The citation should state “Allen JI. The Hepatitis C Screening and Evaluation: Clinical Decision Tool. Gastroenterology 2013; 145(5):1144-45.

Decision Point # 2: Those at high risk, including
any blood transfusions prior to 1992, or history of
intravenous drug use.

The USPSTF recommends screening for HCV
infection in adults at high risk, including
those with any history of intravenous drug
use or blood transfusions prior to 1992
(USPSTF GRADE B Recommendation).ii

Decision Point # 3: Testing for current
intravenous drug users.

The USPSTF recommends screening for HCV
infection in adults at high risk, including
those with any history of intravenous drug
use or blood transfusions prior to 1992
(USPSTF Grade B recommendation).ii

Decision Point #4: Hepatitis C antibody testing.

A person whose anti-HCV test is reactive
should be considered to either 1) have
current HCV infection or 2) have had HCV
infection in the past that has subsequently
resolved (i.e., cleared). To identify persons
with active HCV infection, persons who
initially test anti-HCV positive should be
tested by an HCV nucleic acid test (NAT).ii

Decision Point #6: Counseling and retesting and
other testing as appropriate.

Persons who use or inject illegal drugs
should be advised: to stop using and
injecting drugs; to enter and complete
substance abuse treatment. v

Persons who are at risk for sexually
transmitted diseases should be advised:
that the surest way to prevent the
spread of HIV infection and other STDs
is to have sex with only one uninfected
partner or not to have sex at all; to use
latex condoms correctly and every time
to protect themselves and their partners
from diseases.v

Laboratory monitoring should include
measurement of the serum creatinine
and ALT levels, and HCV RNA by a sensitive
assay at weeks 4, 12 and 24 of treatment,
4 to 12 week intervals thereafter, the
end of treatment, and 24 weeks after
stopping treatment.iii

Decision Point #8: Initial test for HCV:
HCV genotype.

HCV genotyping should be performed in all
HCV-infected persons prior to interferonbased
treatment in order to plan for
the dose and duration of therapy and to
estimate the likelihood of response (Class
I, Level A).iii

The HCV genotype must be assessed
prior to antiviral treatment initiation and
will determine the dose of ribavirin and
treatment decision.iv

Decision Point #11: Initial test for HCV:
HIV antibody.

Because of the high prevalence of HIV/HCV
co-infection, and because the management
of each infection can differ in dually-infected
persons, all HIV-infected persons should be
tested for HCV and all HCV-infected persons
with HIV risk factors should be tested for HIV.iii

Decision Point #12: Initial test for HCV: HBV.
surface antigen.

Because dual infection is associated with
worse prognosis than HCV infection alone
and because the management of each virus
can differ in dually infected persons, all HCVinfected
persons with HBV risk factors should
be tested for HBV.iii

All persons identified with HCV infection
should receive a brief alcohol screening
and intervention as clinically indicated,
followed by referral to appropriate care and
treatment services for HCV infection and
related conditions (Strong recommendation,
moderate quality of evidence).i

i. CDC. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. MMWR. 2012;61(RR- 4):1-32.